The TX HHS Form 3025, Individual Safety Plan, is a practical tool designed to help individuals at risk of abuse or harm identify potential dangers and develop strategies to minimize those risks. This form is typically used in situations where an individual may be vulnerable to abuse, such as in adult mental health settings.
The TX HHS Form 3026 is a crucial document for Intermediate Care Facilities for Individuals with an Intellectual Disability or Related Conditions (ICFs/IID) to submit in response to a random sample review. This form helps ensure that ICFs/IID facilities maintain accurate records of their nursing staff and provide necessary documentation for the health and well-being of individuals under their care.
The TX HHS Form 3028, Hemophilia Assistance Program (HAP) Provider Enrollment, is a crucial document for healthcare providers seeking to participate in the Texas Hemophilia Assistance Program. This form facilitates the enrollment process by gathering essential information about the provider's facility, business structure, and contact details.
The Residential Care Copayment Worksheet (TX HHS Form 1032) is a practical tool designed to help individuals calculate their copayment amounts for residential care services. This form is typically used in situations where an individual requires long-term care services, such as assisted living or nursing home facilities, and needs to determine their monthly copayment amount.
The TX HHS Form 1035, PASRR Consent for Use of Audio-Only and Audio-Visual Communication, is a crucial document that helps solve the problem of facilitating communication between healthcare professionals and individuals receiving specialized services. This form is typically used in situations where in-person visits are not feasible or practical, such as during preadmission screening and resident review (PASRR) assessments.
The TX HHS Form 1038, Consent for the Use of Audio-Only or Audio-Visual Communication, is a crucial document that facilitates communication between individuals with intellectual and developmental disabilities (LIDDA) and their service coordinators. This form helps solve the problem of ensuring that LIDDA clients provide consent for audio-only or audio-visual communication during service coordination visits.
The TX HHS Form 1040 CFC Non-Waiver Packet Information and Checklist is a crucial document that helps solve the problem of determining intellectual disability or related condition for Community First Choice (CFC) services. This form is typically used in situations where an individual requires CFC services, which are managed by a Managed Care Organization (MCO). The person responsible for filling out this form is usually the Legally Authorized Representative (LAR) or the individual themselves.
The TX HHS Form 1041, Refusal of PASRR Mental Illness Specialized Services, is a crucial document for individuals who have been admitted to a nursing facility and are in need of mental illness specialized services. This form helps solve the problem of ensuring that individuals receive the necessary support and services to improve their quality of life and community participation.
The TX HHS Form 3031, Children with Special Health Care Needs (CSHCN) Program Application, is a crucial document for individuals seeking assistance from the Texas Health and Human Services (HHS) CSHCN program. This form helps families access essential healthcare services and support for their children with special needs.
The TX HHS Form 3032, Hemophilia Assistance Program Physical Assessment, is a crucial document that helps facilitate the application process for individuals with hemophilia. This form is typically completed by the applicant's Texas licensed physician to provide medical information and verify the accuracy of the application.
